HIV‑associated Wasting

What is HIV‑associated wasting?

HIV‑associated wasting is an HIV‑related condition characterized by abnormalities in protein synthesis, proteolysis, and lipid metabolism.2 Over time, patients living with HIV may experience unintentional weight loss, which may manifest as a preferential loss of LBM and a relative preservation of fat.3,4 The loss of LBM may be associated with a decline in strength and in the ability to complete tasks.5,6

Who may be at risk?

HIV‑associated wasting is a serious, underdiagnosed condition that may impact a range of patients living with HIV, including those who are well controlled on ART.7,8

HIV‑associated wasting may affect a range of patients 2,7-9

Many of your patients may be at risk for HIV‑associated wasting, including:

  • Newly diagnosed patients 
  • HIV Long-Term Survivors
  • HIV‑positive patients with normal CD4 counts and controlled viral loads 
  • Patients on ART who fail to gain weight
  • Patients on ART with acute infection 
  • Patients with advanced HIV disease 
  • Poor virologic responders 
  • Patients who have been nonadherent to ART 


More men experience HIV‑associated wasting, but it can occur in women, too. 

Many factors contribute to HIV‑associated wasting2,5

The exact causes of HIV‑associated wasting remain unknown and are unique to every patient. HIV‑associated wasting is a diagnosis of exclusion. There are several factors associated with altered metabolism and/or reduced caloric intake that may result in unintentional weight loss in your patients living with HIV.

Opportunistic infections (OIs)7,11-13

  • OIs related to HIV have been shown to increase the risk of unintentional weight loss and may lead to metabolic changes

Inflammatory response14-16

  • Persistent HIV infection leads to long-term immune activation and chronic inflammation, even in HIV‑positive patients on ART with undetectable viral loads
  • In patients living with HIV, this chronic, systemic inflammatory response leads to the ongoing loss of LBM, which may lead to unintentional weight loss

Metabolic pathways4

  • Dysregulation of metabolic pathways can result in inappropriate depletion of LBM, body weight, and a relative preservation of body fat

Endocrine dysfunction17,18

  • In HIV‑positive patients, endocrine dysfunction is a common clinical manifestation
    • There is a high correlation between loss of LBM and hypogonadism in HIV‑positive men who are on ART
    • Among HIV‑positive women, decreased levels of free testosterone are also significantly associated with HIV‑associated wasting

Growth hormone (GH) resistance 2,9,17,19

  • GH secretion and action are affected by nutritional status and changes in body composition
  • In HIV‑associated wasting patients, a pattern of acquired GH resistance is seen, with increased GH and simultaneously decreased concentrations of insulin growth factor-1 (IGF-1)
    • The GH/IGF-1 axis is one of the regulators of muscle protein metabolism that is altered in patients with HIV‑associated wasting

Evidence suggests that altered metabolism can have an important role in the development of HIV‑associated wasting

Serostim® is the only product with anabolic and anticatabolic properties indicated to treat HIV‑associated wasting.1

Are your patients experiencing symptoms of HIV‑associated wasting?

Important Safety Information and Indication

CONTRAINDICATIONS

Acute Critical Illness:  Serostim® should not be initiated in patients with acute critical illness due to complications following open heart or abdominal surgery, multiple accidental trauma or acute respiratory failure.

Active Malignancy: Somatropin is contraindicated in the presence of active malignancy.  Any preexisting malignancy should be inactive and its treatment complete prior to instituting therapy with somatropin. Discontinue somatropin if there is evidence of recurrent activity.

Hypersensitivity: Serostim® is contraindicated in patients with a known hypersensitivity to somatropin or any of its excipients. Systemic hypersensitivity reactions have been reported.

Diabetic Retinopathy: Somatropin is contraindicated in patients with active proliferative or severe non-proliferative diabetic retinopathy.

WARNINGS AND PRECAUTIONS

Acute Critical Illness: Increased mortality (42% vs 19% in somatropin compared to placebo treated) in patients with acute critical illness due to complications following open heart surgery, abdominal surgery or multiple accidental trauma, or those with acute respiratory failure has been reported after treatment with pharmacologic amounts of somatropin.

Concomitant Antiretroviral Therapy: Somatropin has been shown to potentiate HIV replication in vitro, and there was no increase in virus production when antiretroviral agents were added to the culture medium. No significant somatropin-associated increase in viral burden was observed.  All patients received antiretroviral therapy for the duration of treatment during Serostim® clinical trials.

Neoplasms: Patients with preexisting tumors should be monitored for progression or reoccurrence. Monitor patients on somatropin therapy carefully for preexisting nevi.

Impaired Glucose Tolerance/Diabetes: Patients with other risk factors for glucose intolerance should be monitored closely during Serostim® therapy. Cases of new onset impaired glucose tolerance, new onset type 2 diabetes, and exacerbation of preexisting diabetes have been reported in patients receiving Serostim®. Some patients developed diabetic ketoacidosis and diabetic coma and, in some, improved when Serostim® was discontinued and in others persisted. Some of these patients required initiation or adjustment of antidiabetic treatment.

Intracranial Hypertension: Intracranial hypertension (IH) with papilledema, visual changes, headache, nausea, and/or vomiting has been reported usually within the first 8 weeks of somatropin therapy and rapidly resolved after stopping or reducing the somatropin dose. Funduscopic examination should be performed prior to initiating treatment with somatropin and periodically during treatment. If papilledema is observed, treatment should be stopped and restarted at a lower dose after IH-associated symptoms have resolved.

Severe Hypersensitivity: Serious systemic hypersensitivity reactions including anaphylactic reactions and angioedema have been reported with postmarketing use of somatropin products. Patients and caregivers should be informed that such reactions are possible and that prompt medical attention should be sought if an allergic reaction occurs.

Fluid Retention/Carpal Tunnel Syndrome: Increased tissue turgor (swelling, particularly in the hands and feet) and musculoskeletal discomfort (pain, swelling and/or stiffness) may occur during treatment with Serostim®, but may resolve spontaneously, with analgesic therapy, or after reducing the frequency of dosing. Carpal tunnel syndrome may occur and if the symptoms of carpal tunnel do not resolve by decreasing the weekly number of doses, it is recommended that Serostim® treatment be discontinued.

Skin Atrophy: Rotate the injection site to avoid tissue atrophy.

Pancreatitis: Cases of pancreatitis have been reported rarely. Consider pancreatitis in patients who develop persistent severe abdominal pain.

ADVERSE REACTIONS

In clinical trials in HIV‑associated wasting or cachexia the most common adverse reactions (incidence >5%) were arthralgia, myalgia, peripheral edema, arthrosis, nausea, paresthesia, generalized edema, gynecomastia, hypoesthesia and fatigue.

SPECIAL POPULATIONS: 

Somatropin should be used during pregnancy only if clearly needed and with caution in nursing mothers because it is not known whether somatropin is excreted in human milk. The safety and effectiveness of somatropin in pediatric patients with HIV have not been established.  Clinical studies did not include sufficient numbers of subjects > 65 to determine a response different from that of younger patients. Studies have not been conducted in patients with hepatic or renal impairment. Gender-based analysis is not available.

INDICATIONS AND USAGE

Serostim® (somatropin) for injection is indicated for the treatment of HIV patients with wasting or cachexia to increase lean body mass and body weight, and improve physical endurance. Concomitant antiretroviral therapy is necessary.

Please click here full Prescribing Information.

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